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Chamber Directory
The Chamber
Member Center
Membership Benefits
Chamber University
Visitor Information
Events & News
Job Board

The Chamber

Board Member Application

Board of Directors Application

1Personal Information

2Work Information

3Board Experience

4Skills/Knowledge

Personal Information
Name*
First Middle Last Common Name ("Nick Name")
Home Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone*
Personal Email

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Work Information
Employer*
Title*
Employer Address
Street Address Address Line 2 City State ZIP Code
Employer Phone
Employer Email
Type of business organization
Primary service(s) and geographic area served
Primary method of contact
- Work
- Home
- Cell

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Board Experience
Please list any boards, commissions, and/or committees that you serve on, or have served on
(i.e. Business, civic, community, fraternal, political, professional, recreational, religious, social, etc.)
Education/Training/Certification
Have you received any awards or honors that you would like to mention?

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What skills/knowledge are you willing to bring to the board?
Please indicate your experience in the following areas:
Strategic Planning
- Very Experienced
- Some Experience
- Little or No Experience
Fundraising
- Very Experienced
- Some Experience
- Little or No Experience
Board Development
(Recruitment, training, evaluation)
- Very Experienced
- Some Experience
- Little or No Experience
Program Planning & Evaluation
- Very Experienced
- Some Experience
- Little or No Experience
Recruiting, Hiring & Evaluating Personnel
- Very Experienced
- Some Experience
- Little or No Experience
Financial Management & Control
(Budgeting, accounting)
- Very Experienced
- Some Experience
- Little or No Experience
Communication, Public & Media Relations
- Very Experienced
- Some Experience
- Little or No Experience
Participation in Interagency Committees
- Very Experienced
- Some Experience
- Little or No Experience
Organizational Development
- Very Experienced
- Some Experience
- Little or No Experience
Information Technology
- Very Experienced
- Some Experience
- Little or No Experience
Writing, Journalism
- Very Experienced
- Some Experience
- Little or No Experience
Special Events
(Planning, implementation)
- Very Experienced
- Some Experience
- Little or No Experience
For the items marked "Very Experienced" or "Some Experience", please provide details
If not detailed above, please share your experience as a volunteer board or committee member
How do you feel the Chamber would benefit from your involvement on the Board?
Please list any groups, organizations or businesses that you could serve as liason to on behalf of the Bullitt County Chamber of Commerce.
Anything else you would like to share?
Name
This field is for validation purposes and should be left unchanged.

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974684014381656

Connect. Empower. Strengthen.

Together.

Bullitt County Chamber of Commerce
162 S. Buckman
P.O. Box 1656
Shepherdsville, KY 40165

(502) 543-6727

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